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General NPI Number Information
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NPI Number | 1134363872
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Entity Type | Organization
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Legal Business Name | LTC SCRIPTSRX LLC
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Dates
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Enumeration Date | 04/24/2009
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Last Update Date | 04/24/2009
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Provider Practice Location Address
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Address Line | 572 MADDOX DR
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City | ELLIJAY
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State | GA
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Zip | 30540-4000
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Country | US
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Telephone | 706-635-7931
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Fax | 706-635-1102
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Provider Business Mailing Address
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Address Line | 1002 N PARKERSON AVE
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City | CROWLEY
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State | LA
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Zip | 70526-3613
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Country | US
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Telephone | 337-783-7200
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Fax | 337-785-3116
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Authorized Official
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Title or Position | CONTROLLER
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Name | STEVEN A MARAIST
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Credential |
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Telephone | 337-783-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State | GA
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